A common injury, especially among athletes and people of advancing age, is the complete or partial detachment of tendons, ligaments, or other soft tissues from bone. Tissue detachment may occur during a fall, by overexertion, or for a variety of other reasons. Surgical intervention is often needed, particularly when tissue is completely detached from its associated bone. Currently available devices for tissue attachment include screws, staples, suture anchors, and tacks, at least some of which are used in conjunction with suture to perform repair procedures.
Devices that use suture to help secure tissue to bone often present difficulties in suture management during the repair procedure. Even when just a single suture filament is used as part of a repair system, that filament typically has multiple limbs that must be accounted for during the repair. For example, in some embodiments a filament includes two limbs that extend from one side of a suture anchor and two other limbs that extend from the other side of the suture anchor. When a surgeon is utilizing an inserter tool to implant the anchor, the four terminal ends can be in the surgeon's way. However, once the anchor is implanted, surgeons generally want to be able to easily access the terminal ends that were previously in their way so they can use the suture to secure the tissue to bone.
Features currently used to assist in suture management by placing terminal ends out of the way during anchor implantation often require the surgeon to perform multiple steps to subsequently access the terminal ends after the anchor is implanted. For example, an inserter tool may have suture terminal ends extending from one side of the anchor stored in a first location and suture terminal ends extending from the other side of the anchor stored in a second location a distance apart from the first location. In order to access all of the terminal ends for use in securing tissue to bone, the surgeon must perform one action to access the terminal ends stored at the first location and another action to access the terminal ends stored at the second location. These actions are further complicated by the need to hold the accessed set of terminal ends while performing the second action to access the second set of terminal ends.
Additionally, devices currently used to manage sutures can be difficult to use, which can lead to misuse by the operator. Misuse of a suture management device can defeat its intended purpose. For example, if a suture management device is configured to hold open a loop of a particular portion of suture until terminal ends are passed through, but the surgeon mistakenly collapses the loop before passing the terminal ends through the loop, such failure can result in a suture that is no longer useful to the surgeon. The surgeon may then have to remove the anchor and suture and begin the implantation portion of the procedure again.
Accordingly, it is desirable to provide devices, systems, and methods that make it easy for surgeons to manage suture when implanting anchors, but also easy to access and use the suture after the anchor is implanted. It is also desirable to reduce the number of steps to be performed by the surgeon to implant the anchor, access the suture after the anchor is implanted, and subsequently use the suture to attach tissue to bone. Further, it is desirable to incorporate mechanisms into devices and systems used in soft tissue repair that reduce the likelihood of operator errors.